Provider Demographics
NPI:1639745144
Name:AVILES ZAVALETA, ALEJANDRA
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:AVILES ZAVALETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10230 ARTESIA BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6769
Mailing Address - Country:US
Mailing Address - Phone:562-356-9692
Mailing Address - Fax:
Practice Address - Street 1:10230 ARTESIA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6768
Practice Address - Country:US
Practice Address - Phone:562-356-9692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2024-09-25
Deactivation Date:2021-08-03
Deactivation Code:
Reactivation Date:2024-04-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No172V00000XOther Service ProvidersCommunity Health Worker